Model-driven segmentation of X-ray left ventricular angiograms

X-ray left ventricular (LV) angiography is an important imaging modality to assess cardiac function. Using a contrast fluid a 2D projection of the heart is obtained. In current clinical practice cardiac function is analyzed by drawing two contours manually: one in the end diastolic (ED) phase and one in the end systolic (ES) phase. From the contours the LV volumes in these phases are calculated and the patient__s ejection fraction is assessed. Drawing these contours manually is a cumbersome and time-consuming task for a medical doctor. Furthermore, manual drawing introduces inter- and intra-observer variabilities. The focus of the research presented in this thesis was to automate the process of contour drawing in X-ray LV angiography. The developed method is based on Active Appearance Models. These statistical models, in which the cardiac shape and the cardiac appearance are modeled, have proven to be able to mimic the drawing behavior of an expert cardiologist. The clinical parameters, as determined by the automated method, showed a similar degree of accuracy as when determined by an expert. Furthermore, the required time for patient analysis was reduced considerably and the inter- and intra-observer variabilities were structurally decreased.UBL - phd migration 201

Automated volume measurements in echocardiography by utilizing expert knowledge

Left ventricular (LV) volumes and ejection fraction (EF) are important parameters for diagnosis, prognosis, and treatment planning in patients with heart disease. These parameters are commonly measured by manual tracing in echocardiographic images, a procedure that is time consuming, prone to inter- and intra-observer variability, and require highly trained operators. This is particularly the case in three-dimensional (3D) echocardiography, where the increased amount of data makes manual tracing impractical. Automated methods for measuring LV volumes and EF can therefore improve efficiency and accuracy of echocardiographic examinations, giving better diagnosis at a lower cost. The main goal of this thesis was to improve the efficiency and quality of cardiac measurements. More specifically, the goal was to develop rapid and accurate methods that utilize expert knowledge for automated evaluation of cardiac function in echocardiography. The thesis presents several methods for automated volume and EF measurements in echocardiographic data. For two-dimensional (2D) echocardiography, an atlas based segmentation algorithm is presented in paper A. This method utilizes manually traced endocardial contours in a validated case database to control a snake optimized by dynamic programming. The challenge with this approach is to find the most optimal case in the database. More promising results are achieved in triplane echocardiography using a multiview and multi-frame extension to the active appearance model (AAM) framework, as demonstrated in paper B. The AAM generalizes better to new patient data and is based on more robust optimization schemes than the atlas-based method. In triplane images, the results of the AAM algorithm may be improved further by integrating a snake algorithm into the AAM framework and by constraining the AAM to manually defined landmarks, and this is shown in paper C. For 3D echocardiograms, a clinical semi-automated volume measurement tool with expert selected points is validated in paper D. This tool compares favorably to a reference measurement tool, with good agreement in measured volumes, and with a significantly lower analysis time. Finally, in paper E, fully automated real-time segmentation in 3D echocardiography is demonstrated using a 3D active shape model (ASM) of the left ventricle in a Kalman filter framework. The main advantage of this approach is its processing performance, allowing for real-time volume and EF estimates. Statistical models such as AAMs and ASMs provide elegant frameworks for incorporating expert knowledge into segmentation algorithms. Expert knowledge can also be utilized directly through manual input to semi-automated methods, allowing for manual initialization and correction of automatically determined volumes. The latter technique is particularly suitable for clinical routine examinations, while the fully automated 3D ASM method can extend the use of echocardiography to new clinical areas such as automated patient monitoring. In this thesis, different methods for utilizing expert knowledge in automated segmentation algorithms for echocardiography have been developed and evaluated. Particularly in 3D echocardiography, these contributions are expected to improve efficiency and quality of cardiac measurements

Automated analysis of 3D echocardiography

In this thesis we aim at automating the analysis of 3D echocardiography, mainly targeting the functional analysis of the left ventricle. Manual analysis of these data is cumbersome, time-consuming and is associated with inter-observer and inter-institutional variability. Methods for reconstruction of 3D echocardiographic images from fast rotating ultrasound transducers is presented and methods for analysis of 3D echocardiography in general, using tracking, detection and model-based segmentation techniques to ultimately fully automatically segment the left ventricle for functional analysis. We show that reliable quantification of left ventricular volume and mitral valve displacement can be achieved using the presented techniques.SenterNovem (IOP Beeldverwerking, grant IBVC02003), Dutch Technology Foundation STW (grant 06666)UBL - phd migration 201

LEFTV ENTRICULARW ALL MOTION ESTIMATION AND FUNCTIONAL QUANTIFICATION IN VENTRICULOGRAMS

Este trabajo describe un sistema semiautomático, fundamentado en técnicas asistidas por computadora, que permite valorar el funcionamiento del ventrículo izquierdo en imágenes ventriculográficas. El estudio se centra en el análisis de dos instantes del ciclo cardiaco: diástole y sístole final. El proceso de segmentación es realizado de forma manual por parte del especialista utilizando una herramienta interactiva. La valoración del movimiento regional de la pared ventricular es obtenida a través de la cuantificación del desplazamiento a lo largo de 100 radios generados entre los dos contornos ventriculares; con estas mediciones es posible generar una valoración porcentual de radios normales, hyperkinéticos e hypokinéticos.This work reports a semiautomatic computer based system,that enables quantification of the Left ventricular function based on X-rays ventriculograms. The system is centered on theanalysis of images located attwo instants of the heart cycle(end-diastole and end-systole). The segmentation process is performed manually by a specialist using a custom interactive software tool. The quantification of regional left ventricular wall motion is obtained through the estimation of the distance between two overlayed contours along 100 radios. Using this information it is possible to classify the motion of the Left ventricular wall as normal, hyperkinetics or hypokinetics. Additionally several descriptive parameters of the cardiac function are estimated

Evaluación de técnicas para la detección de la cavidad ventricular izquierda en imágenes de angiografía cardiaca por rayos X

En este trabajo, se compara el desempeño de tres (3) técnicas diseñadas para la detección de la cavidad ventricular izquierda en imágenes de angiografía cardiaca, con el fin de obtener la información necesaria para cuantificar la función ventricular. Las técnicas se basan en a) aproximación lineal (AL), b) modelos de cuerpos deformables (snake), y c) relaciones funcionales y técnicas de agrupamiento (RFTA). La comparación se establece tomando como referencia los contornos trazados por especialistas cardiólogos que definen la cavidad ventricular, y siguiendo una metodología que permite cuantificar la diferencia entre la forma final obtenida por cada método propuesto y la forma real trazada por el especialista. Los resultados comprueban que la técnica basada en modelos de cuerpos deformables es más robusta frente a cambios topológicos tales como suavidad y curvatura presentes en la forma ventricular izquierda en comparación con las otras dos técnicas propuestas. Sin embargo, la técnica basada en snake, al igual que la basada en AL, necesita un conjunto de puntos iniciales establecidos de forma manual cerca de la forma a extraer, a diferencia de la técnica de RFTA, la cual extrae la forma ventricular de manera automática

Automated image analysis techniques for cardiovascular magnetic resonance imaging

The introductory chapter provides an overview of various aspects related to quantitative analysis of cardiovascular MR (CMR) imaging studies. Subsequently, the thesis describes several automated methods for quantitative assessment of left ventricular function from CMR imaging studies. Several novel computer algorithms are introduced and validated for automated segmentation of short-axis CMR images and validated by comparing functional results derived from automated segmentation with results derived from manually traced contours. In addition an automated method is presented for assessment of flow through the aorta based on Phase-Contrast flow velocity mapping MRI. Finally a method is presented for accurate assessment of the thickness of the left ventricular myocardium taking advantage of the three-dimensional nature of MRI.UBL - phd migration 201

Automated Analysis of 3D Stress Echocardiography

__Abstract__ The human circulatory system consists of the heart, blood, arteries, veins and capillaries. The heart is the muscular organ which pumps the blood through the human body (Fig. 1.1,1.2). Deoxygenated blood flows through the right atrium into the right ventricle, which pumps the blood into the pulmonary arteries. The blood is carried to the lungs, where it passes through a capillary network that enables the release of carbon dioxide and the uptake of oxygen. Oxygenated blood then returns to the heart via the pulmonary veins and flows from the left atrium into the left ventricle. The left ventricle then pumps the blood through the aorta, the major artery which supplies blood to the rest of the body [Drake et a!., 2005; Guyton and Halt 1996]. Therefore, it is vital that the cardiovascular system remains healthy. Disease of the cardiovascular system, if untreated, ultimately leads to the failure of other organs and death

Computer-aided detection of wall motion abnormalities in cardiac MRI

With the increasing prevalence and hospitalization rate of ischaemic heart disease, an explosive growth of diagnostic imaging for ischaemia is ongoing. Clinical decision making on revascularization procedures requires reliable viability assessment to assure long-term patient survival and to elevate cost effectiveness of the therapy and treatment. As such, the demand is increasing for a computer-assisted diagnosis (CAD) method for ischaemic heart disease that supports clinicians with an objective analysis of infarct severity, a viability assessment or a prediction of potential functional improvement before performing revascularization. The goal of this thesis was to explore novel mechanisms that can be used for CAD in ischaemic heart disease, particularly through wall motion analysis from cardiac MR images. Existing diagnostic treatment of wall motion analysis from cardiac MR relies on visual wall motion scoring, which suffers from inter- and intra-observer variability. To minimize this variability, the automated method must contain essential knowledge on how the heart contracts normally. This enables automatic quantification of regional abnormal wall motion, detection of segments with contractile reserve and prediction of functional improvement in stress.1. Bontius Stichting inz. Doelfonds beeldverwerking, 2. Foundation Imago, 3. ASCI research school, and 4. Library of the University of Leiden.UBL - phd migration 201

3D reconstruction of coronary arteries from angiographic sequences for interventional assistance

Introduction -- Review of literature -- Research hypothesis and objectives -- Methodology -- Results and discussion -- Conclusion and future perspectives